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Hijos-Mallada G, Sostres C, Gomollón F. NSAIDs, gastrointestinal toxicity and inflammatory bowel disease. Gastroenterol Hepatol 2021; 45:215-222. [PMID: 34157367 DOI: 10.1016/j.gastrohep.2021.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/11/2021] [Indexed: 01/06/2023]
Abstract
Non-steroidal antiinflammatory drugs (NSAIDs) are currently one of the most widely used drugs. The use of NSAIDs is associated with gastrointestinal toxicity, affecting both upper gastrointestinal tract (peptic ulcer disease) and lower gastrointestinal tract (NSAID-induced enteropathy). NSAIDs use has been associated with an increased risk of clinical relapse in inflammatory bowel disease patients. In this article, we review the upper and lower gastrointestinal toxicity of NSAIDs, with a focus on the risks and specific data of these drugs in inflammatory bowel disease patients, giving recommendations for its appropriate use in the clinical practice. Although evidence is scarce, short-term use of NSAIDs appears to be safe, and the data available suggest that selective COX-2 inhibitors are the safer option. NSAIDs should be avoided as long-term treatment or with high doses, especially in patients with active inflammation.
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Affiliation(s)
- Gonzalo Hijos-Mallada
- Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Instituto de Investigación Sanitaria (ISS) Aragón, Zaragoza, España.
| | - Carlos Sostres
- Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Instituto de Investigación Sanitaria (ISS) Aragón, Zaragoza, España
| | - Fernando Gomollón
- Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Instituto de Investigación Sanitaria (ISS) Aragón, Zaragoza, España; Departamento de Medicina, Facultad de Medicina, Universidad de Zaragoza, Zaragoza, España
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Arisan ED, Akar RO, Rencuzogullari O, Obakan Yerlikaya P, Coker Gurkan A, Akın B, Dener E, Kayhan E, Palavan Unsal N. The molecular targets of diclofenac differs from ibuprofen to induce apoptosis and epithelial mesenchymal transition due to alternation on oxidative stress management p53 independently in PC3 prostate cancer cells. Prostate Int 2019; 7:156-65. [PMID: 31970141 DOI: 10.1016/j.prnil.2019.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 08/19/2019] [Accepted: 09/25/2019] [Indexed: 01/16/2023] Open
Abstract
Background Prostate cancer is the most common type of cancer among men. Studies showed that the regular use of nonsteroidal antiinflammatory drugs might reduce disease progression risk for prostate cancer patients with prostate cancer. We evaluated the effects of ectopic expression of p53 on the biological functions of ibuprofen and diclofenac. Materials and methods For this purpose, We investigated cell death decision pathways related to survival and aggressive cellular phenotypes such as extrinsic/intrinsic apoptosis decision, Protein Kinase B/ Forkhead box O (AKT/FoxO) axis, mitogen-activated protein kinases (MAPKs), reactive oxygen species (ROS) generation, and EMT (epithelial mesenchymal transition) in wild type and p53 + PC3 prostate cancer cells. Results and Conclusions Ibuprofen (1 mM) and diclofenac (250 μM) effectively induced cell cycle arrest and led to apoptosis via modulating both extrinsic and intrinsic pathways. However, diclofenac was the only drug to generate ROS intermediates. Diclofenac triggered a typical EMT process with downregulated E-cadherin and upregulated N-cadherin, vimentin, and Snail in PC3 cells, regardless of p53 expression. In conclusion, although both drugs are effective on cell death mechanism, only diclofenac caused EMT because of increased ROS generation independent of p53. On the other hand, ibuprofen could inhibit metastasis via upregulating E-cadherin. The biological targets of both nonsteroidal antiinflammatory drugs are different to highlight their role in cell survival and death axis.
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Abstract
This article reviews the mechanisms of action, clinical use, and recent scientific evidence for the use of nonsteroidal antiinflammatory drugs, grapiprant, acetaminophen (paracetamol), metamizole (dipyrone), and corticosteroids in pain management. The discussion is presented with an emphasis on the treatment of acute pain.
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Ikkere LE, Perkons I, Sire J, Pugajeva I, Bartkevics V. Occurrence of polybrominated diphenyl ethers, perfluorinated compounds, and nonsteroidal anti-inflammatory drugs in freshwater mussels from Latvia. Chemosphere 2018; 213:507-516. [PMID: 30248497 DOI: 10.1016/j.chemosphere.2018.09.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/04/2018] [Accepted: 09/05/2018] [Indexed: 06/08/2023]
Abstract
The occurrence of polybrominated diphenyl ethers (PBDE), perfluorinated compounds (PFC), and nonsteroidal anti-inflammatory drugs (NSAID) in Latvian freshwater ecosystems was evaluated by using filter-feeding mussels as bioindicators. Twenty four samples of mussels were collected from freshwater bodies throughout the territory of Latvia during the summer of 2017. PBDE contamination was ubiquitous, reaching the highest total concentration of 193.2 pg g-1 w.w. BDE-209 was the most abundant compound, followed by penta-BDE components BDE-49, -100, -99, -153, -154, and -47 in decreasing order. The levels of PFCs in Latvian mussels were generally lower than those reported from other regions. Perfluorooctanoic acid (PFOA) was more common in mussels than perfluorooctane sulfonate (PFOS). Ibuprofen was the only NSAID detected in mussels during this study (detection frequency 50%). The observed concentrations of this compound varied between 0.52 and 109 ng g-1 w.w., being noticeably higher than reported by other authors. Overall, the results indicate that among the three analysed groups of contaminants, ibuprofen is present in Latvian freshwater environment at relatively high levels and further monitoring should be carried out.
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Affiliation(s)
- L E Ikkere
- Institute of Food Safety, Animal Health and Environment "BIOR", Lejupes iela 3, Riga LV-1076, Latvia; University of Latvia, Jelgavas iela 1, Riga LV 1004, Latvia.
| | - I Perkons
- Institute of Food Safety, Animal Health and Environment "BIOR", Lejupes iela 3, Riga LV-1076, Latvia; University of Latvia, Jelgavas iela 1, Riga LV 1004, Latvia
| | - J Sire
- Latvian Environment, Geology and Meteorology Centre, Maskavas iela 165, Riga LV 1019, Latvia; University of Latvia, Jelgavas iela 1, Riga LV 1004, Latvia
| | - I Pugajeva
- Institute of Food Safety, Animal Health and Environment "BIOR", Lejupes iela 3, Riga LV-1076, Latvia
| | - V Bartkevics
- Institute of Food Safety, Animal Health and Environment "BIOR", Lejupes iela 3, Riga LV-1076, Latvia; University of Latvia, Jelgavas iela 1, Riga LV 1004, Latvia
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5
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Abstract
Barrett's esophagus is common in Western countries, but progression to esophageal adenocarcinoma is uncommon. Chemoprevention therefore needs to consider whether benefits outweigh risks given an otherwise healthy population. This will depend on the particular population at risk and the relative safety of a potential preventive agent. Most evidence regarding the potential benefit of chemoprevention of Barrett's esophagus and prevention of progression to esophageal adenocarcinoma is based on observational studies such as case-control and cohort studies. Given the potential benefits and relatively low risks, patients with BE should receive once-daily PPI therapy, but routine use of twice-daily PPI is not recommended unless necessitated by poor control of reflux symptoms or esophagitis. Recent data suggest that the inverse associations between aspirin/NSAID use and esophageal adenocarcinoma may be the result of reducing neoplastic progression (from metaplasia to dysplasia and carcinoma) rather than initiation of Barrett's esophagus. While substantial associative data suggest a potential benefit of aspirin and nonaspirin NSAIDs in reducing the risk of progression of Barrett's esophagus, the low risk of progression and the potential risks (gastrointestinal bleeding, complicated ulcer disease, hemorrhagic stroke) do not warrant routine use, unless dictated by cardiovascular risk. Chemoprevention after mucosal ablation in those at highest risk of post-ablation recurrence (dysplastic Barrett's) is currently under investigation.
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Affiliation(s)
- Robert S Bresalier
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer, 1515 Holcombe Boulevard Unit 1466, Houston, TX, 77030, USA.
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Modena B, White AA, Woessner KM. Aspirin and Nonsteroidal Antiinflammatory Drugs Hypersensitivity and Management. Immunol Allergy Clin North Am 2017; 37:727-49. [PMID: 28965637 DOI: 10.1016/j.iac.2017.07.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Aspirin and nonsteroidal antiinflammatory drugs (NSAIDs) are widely used in the United States and throughout the world for a variety of indications. Several unique hypersensitivity syndromes exist to this class of medications, making them one of the common reasons for consultation to the allergist. The lack of any laboratory-based diagnostic studies to assist in identifying the culprits in these reactions make evaluation of aspirin and NSAID hypersensitivity challenging. Identifying patients appropriate for oral challenge and/or desensitization protocols is the standard pragmatic approach to this issue when it arises.
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Tang M, Xue L, Shen Y, Bo L, Yang R, Wen J, Zhang Y, Liu Z, Fu J. Efficacy of long-term nonsteroidal antiinflammatory drug treatment on magnetic resonance imaging-determined bone marrow oedema in early, active axial spondyloarthritis patients. Clin Rheumatol 2017; 37:245-250. [PMID: 28497237 DOI: 10.1007/s10067-017-3666-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/03/2017] [Accepted: 04/25/2017] [Indexed: 11/25/2022]
Abstract
To assess the efficacy of long-term treatment with nonsteroidal antiinflammatory drugs (NSAIDs) on bone marrow oedema (BMO) of the sacroiliac joint in newly diagnosed axial spondyloarthritis (SpA) with a symptom duration of less than 4 years, a single-center, open-label study in a cohort of consecutive patients with newly diagnosed axial SpA was conducted. Eligible patients had magnetic resonance imaging (MRI)-determined BMO of the sacroiliac joint at baseline, had a symptom duration of less than 4 years, and were naïve to NSAIDs. After the baseline MRI, an optimal dose of NSAID was administered for 24 or 48 weeks. BMO of sacroiliac joint was quantified by applying the Spondyloarthritis Research Consortium of Canada (SPARCC) system. Disease activity was expressed using the Ankylosing Spondylitis Disease Activity Score (ASDAS). Primary end points were improvement in BMO of sacroiliac joint at week 24 or week 48. Forty-three patients were recruited, and 33 patients eventually completed the study, including 10 patients having follow-up MRI at week 24 and 23 patients having follow-up MRI at week 48. Overall, the mean of SPARCC score decreased from 21.8 ± 16.1 at baseline to 10.2 ± 12.8 at follow-up (p < 0.001). 75.8% of the patients displayed a minimally important change, and 30.3% became free of BMO. The mean of ASDAS-CRP decreased from 3.1 ± 1.0 at baseline to 2.1 ± 1.0 at follow-up (p < 0.001). Long-term treatment with optimal dose NSAIDs could significantly alleviate BMO of sacroiliac joint in early and active axial SpA.
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Affiliation(s)
- Mei Tang
- Department of Rheumatology and Immunology, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Leixi Xue
- Department of Rheumatology and Immunology, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yueping Shen
- Department of Epidemiology and Medical Statistics, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Lin Bo
- Department of Rheumatology and Immunology, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Ru Yang
- Department of Rheumatology and Immunology, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jian Wen
- Department of Rheumatology and Immunology, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yi Zhang
- Department of Rheumatology and Immunology, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhichun Liu
- Department of Rheumatology and Immunology, the Second Affiliated Hospital of Soochow University, Suzhou, China.
- the Second Affiliated Hospital of Soochow University, Sanxiang Road No.1055, Suzhou, Jiangsu, 215000, People's Republic of China.
| | - Jinxiang Fu
- Department of Hematology, the Second Affiliated Hospital of Soochow University, Suzhou, China.
- the Second Affiliated Hospital of Soochow University, Sanxiang Road No.1055, Suzhou, Jiangsu, 215000, People's Republic of China.
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Abstract
This article is an update on pain management in the dental care setting for adult and pediatric patients. The 3 main categories of analgesic medications are examined: (1) opioids, (2) nonsteroidal antiinflammatory drugs (NSAIDs), and (3) nonopioid, non-NSAID medications. Pharmacology, side effects, patient selection, and treatment strategies and principles are examined. The information provided is aimed to facilitate the clinical perspective and update the oral health care clinician on providing safe and effective analgesia to adult and pediatric patients.
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Affiliation(s)
- Constantinos Laskarides
- Advanced Residency Program, Oral & Maxillofacial Surgery, Tufts Medical Center, Tufts University, One Kneeland Street, Boston, MA 02111, USA.
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Abstract
In the intensive care unit, vigilance is needed to manage nonvariceal upper gastrointestinal bleeding. A focused history and physical examination must be completed to identify inciting factors and the need for hemodynamic stabilization. Although not universally used, risk stratification tools such as the Blatchford and Rockall scores can facilitate triage and management. Urgent evaluation for nonvariceal upper gastrointestinal bleeds requires prompt respiratory assessment, and identification of hemodynamic instability with fluid resuscitation and blood transfusions if necessary. Future studies are needed to evaluate the indication, safety, and efficacy of emerging endoscopic techniques.
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Abstract
Cesarean deliveries can be associated with moderate to severe postoperative pain. Appropriate management of pain is important because it results in better patient satisfaction, earlier mobilization, and improved maternal-infant bonding. There are many individual options for treatment of pain; however, multimodal analgesic therapy has become the mainstay of treatment. In this article, the epidemiology of postcesarean delivery pain, pain mechanisms, and the multiple options available to providers for treatment of postoperative pain are discussed.
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Soubrier M, Rosenbaum D, Tatar Z, Lahaye C, Dubost JJ, Mathieu S. Vascular effects of nonsteroidal antiinflammatory drugs. Joint Bone Spine 2013; 80:358-62. [PMID: 23796731 DOI: 10.1016/j.jbspin.2012.12.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2012] [Indexed: 12/11/2022]
Abstract
The effect of nonsteroidal antiinflammatory drugs (NSAIDs) on the risk of cardiovascular events remains controversial. Among NSAIDs, only low-dose aspirin exerts protective vascular effects. Low-dose aspirin has been proven effective for secondary prevention. For primary prevention, the usefulness of low-dose aspirin is debated, as illustrated by the differences in recommendations across countries. NSAIDs other than aspirin, whether COX-2 selective or nonselective, increase the risk of cardiovascular events. Among them, naproxen is associated with the smallest risk increase. In patients with a history of coronary artery disease, diclofenac seems to carry the greatest risk, but all NSAIDs should be avoided. Uncertainties persist about aspirin interactions with other NSAIDs and with proton pump inhibitors. An adverse effect of acetaminophen on the risk of cardiovascular disease cannot be completely ruled out.
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Affiliation(s)
- Martin Soubrier
- Service de rhumatologie, hôpital G.-Montpied, BP 69, 63003 Clermont-Ferrand, France.
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Moon SH, Kim MH. Prophecy about post-endoscopic retrograde cholangiopancreatography pancreatitis: From divination to science. World J Gastroenterol 2013; 19:631-637. [PMID: 23429236 PMCID: PMC3574588 DOI: 10.3748/wjg.v19.i5.631] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 12/28/2012] [Accepted: 01/13/2013] [Indexed: 02/06/2023] Open
Abstract
One unresolved issue of endoscopic retrograde cholangiopancreatography (ERCP) is post-ERCP pancreatitis (PEP), which occurs in up to 40% of patients. Identification of risk factors for PEP is especially important in the field of ERCP practice because it may assist physicians in taking protective measures in situations with high risk. A decade ago, Freeman et al meticulously evaluated a large number of potentially relevant risk factors for PEP, which can be divided into patient-related and procedure-related issues. In this commentary, we summarize this classic article and reevaluate the risk factors for PEP from the current point of view. This is followed by assessment of strategies for prevention of PEP that can be divided into mechanical and pharmacologic methods.
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Fujinami H, Kudo T, Hosokawsa A, Ogawa K, Miyazaki T, Nishikawa J, Kajiura S, Ando T, Ueda A, Sugiyama T. A study of the changes in the cause of peptic ulcer bleeding. World J Gastrointest Endosc 2012; 4:323-7. [PMID: 22816013 PMCID: PMC3399011 DOI: 10.4253/wjge.v4.i7.323] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 02/02/2012] [Accepted: 07/01/2012] [Indexed: 02/05/2023] Open
Abstract
AIM: To clarify the frequency of and changes in the cause of peptic ulcer bleeding.
METHODS: This study retrospectively evaluated the out- and inpatients who underwent endoscopy between 2002 to 2008. The subjects were patients presenting with peptic ulcer bleeding. The details of these patients were obtained from their endoscopic reports and medical records.
RESULTS: The rates of Helicobacter pylori (H. pylori) infection were significantly low (P = 0.039), while the proportion of nonsteroidal antiinflammatory drugs (NSAIDs) users and vascular disease significantly increased over the period studied (P = 0.034 and P = 0.04, respectively). However, there was no significant difference in the proportion of low-dose aspirin users (P = 0.832).
CONCLUSION: It’s found that the primary cause of peptic ulcer bleeding changed from H. pylori infection to use of NSAIDs over the 7-year period of study. It seems that the number of low-dose aspirin users has increased with the increase in the proportion of vascular disease. It is necessary to take measures to prevent peptic ulcer bleeding among NSAIDs and low dose aspirin users.
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Affiliation(s)
- Haruka Fujinami
- Haruka Fujinami, Takahiko Kudo, Ayumu Hosokawsa, Kouhei Ogawa, Takako Miyazaki, Jun Nishikawa, Shinya Kajiura, Takayuki Ando, Akira Ueda, Toshiro Sugiyama, Department of Gastroenterology, University of Toyama, 2630 Sugitani, Toyama 9300194, Japan
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Biswas C, Pal A, Acharya A. A comparative study of efficacy of oral nonsteroidal antiinflammatory agents and locally injectable steroid for the treatment of plantar fasciitis. Anesth Essays Res 2011; 5:158-61. [PMID: 25885380 PMCID: PMC4173392 DOI: 10.4103/0259-1162.94756] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To compare the effectiveness of oral nonsteroidal antiinflammatory drugs (NSAIDs) and locally injectable steroid (methylprednisolone) in the treatment of plantar fasciitis. MATERIALS AND METHODS One hundred and twenty subjects with unilateral plantar fasciitis were recruited and randomly allocated to two study groups. Group I (NSAIDs group) (n=60) received oral tablet diclofenac (50 mg) and paracetamol (500 mg) twice a day (BD) along with tab. ranitidine 150 mg BD. Group II (injectable steroid group) (n=60) received injection of 1 ml of methylprednisolone (Depomedrol) (40 mg) and 2 ml of 0.5% bupivacaine into the inflammed plantar fascia. Pain intensity was measured using 10 cm visual analog scale (VAS). Subjects were evaluated clinically before, and 1 week, 2 weeks, 4 weeks, and 8 weeks (2 months) after the initiation of treatment in both the groups. The outcome was assessed in terms of VAS score and recurrence of the heel pain. STATISTICAL ANALYSIS USED "Z" test and Chi-square test were used wherever applicable. RESULTS Pain relief was significant after steroid injection (P<0.001) and the improvement was sustained. The recurrence of heel pain was significantly higher in the oral NSAIDS group (P<0.001). CONCLUSION Local injection of steroid is more effective in the treatment of plantar fasciitis than oral NSAIDs.
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Affiliation(s)
- Chaitali Biswas
- Department of Anaesthesiology, Calcutta National Medical College, Kolkata, India
| | - Anirban Pal
- Department of Anaesthesiology, Calcutta National Medical College, Kolkata, India
| | - Amita Acharya
- Department of Anaesthesiology, Bangur Institute of Neurosciences, Kolkata, India
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Abstract
The effects of drugs on the gastrointestinal tract are diverse and depend on numerous factors. Diagnosis is centered on histologic findings, with mostly nonspecific patterns of injury that must be interpreted in the correct clinical context. Nonsteroidal antiinflammatory drugs are a common cause of drug-induced gastrointestinal injury, with effects primarily in the gastric mucosa but also throughout the gastrointestinal tract. Another common class of drugs causing a variety of pathologic findings in the gut is chemotherapeutic agents. This article discusses the differential diagnosis of the various patterns of injury, including ischemic damage, and the histologic findings specific for certain drugs.
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Affiliation(s)
- Ilyssa O Gordon
- Department of Pathology, University of Chicago Medical Center, 5841 South Maryland Avenue, MC 6101, Chicago, IL 60637, USA
| | - Vani Konda
- Section of Gastroenterology, Department of Medicine, University of Chicago Medical Center, 5841 South Maryland Avenue, MC 4076, Chicago, IL 60637, USA
| | - Amy E Noffsinger
- Department of Pathology, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH 45267-0529, USA.
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